Sleep disordered breathing (SDB) is an independent risk factor for cardiovascular disease. It is known to be associated more frequently with men than women, particularly in the premenopausal age range. The goal of this study is to evaluate gender differences among Korean patients diagnosed with SBD. This study included 309 patients who visited our Sleep Clinic due to sleep-related symptoms and were diagnosed with SDB by overnight polysomnography (PSG). We analyzed age, gender, body mass index, various PSG indices including sleep stages, apnea-hypopnea index (AHI) and AHI ratio in rapid eye movement (REM) versus non-REM (NREM) sleep stages (R:N ratio). Of those 309 patients diagnosed with obstructive sleep apnea, 217 (70.2%) were men (mean age 51.05 ± 12.64 years) and 92 (29.8%) were women (mean age 64.53 ± 10.43 years). The mean AHI during total sleep time was 30.34 ± 21.17 in men and 21.47 ± 17.14 in women (P < 0.001). The AHI in NREM sleep was higher in men than in women (30.97 ± 22.39 versus 20.19 ± 18.17, P < 0.001), whereas the AHI in REM sleep was not significantly different between men and women (25.73 ± 21.61 versus 28.00 ± 21.76, P = 0.402). REM SDB with R:N ratio higher than 2.0 was more frequently observed in women than in men, 34.8% (32/92) of women, compared with 11.9% (26/217) in men (P < 0.001). Interestingly, the mean R:N ratio tended to decrease with increasing age in women, but remained relatively constant in men. The prevalence of REM SDB was higher in women than in men, and the gender difference was the most prominent in women with the age < 60 years old compared to age-matched and older men or women > 60 years old. These findings suggest the possibility of different pathophysiologic mechanisms of SDB between genders and also between NREM versus REM sleep, which can be partly explained by the influence of female sex hormones.

Katz, E. and White, D. (2004) Genioglossus Activity during Sleep in Normal Control Subjects and Children with Obstructive Sleep Apnea. American Journal of Respiratory and Critical Care Medicine, 170, 553-560.http://dx.doi.org/10.1164/rccm.200403-262OC

<span “=””>Associations between depressive symptoms, dysfunctional eating behaviors and attitudes, higher food intake and body mass index (BMI) have been previously observed. However, few studies have assessed these variables in the same study. The first objective is to compare, in a natural setting environment, the profile of women reporting lower or higher levels of depressive symptoms in terms of food intake, eating behaviors and attitudes, and BMI. The second objective is to test mediational models for which the link between depressive symptoms and food intake would be mediated by eating behaviors and attitudes or BMI. Weight-preoccupied women were recruited (n = 323), and their level of depressive symptoms was assessed using the Beck Depression Inventory. The median score was used to create two groups (lower ≤ 13; higher > 13). A web-based food-frequency questionnaire, the Three-Factor Eating Questionnaire, and the Intuitive Eating Scale were completed. BMI was calculated from reported body weight and height. Compared to women with a lower level of depressive symptoms, those with a higher level of depressive symptoms reported a higher energy intake (p = 0.02), and a higher consumption of savoury foods (p = 0.02). These women also had higher scores of disinhibition (p < 0.0001) and susceptibility to hunger (p = 0.0002), ate less intuitively (p < 0.03), and had a higher BMI (p = 0.005). Association between depressive symptoms and energy intake was mediated by disinhibition, susceptibility to hunger and eating for physical rather than emotional reasons, while the role of BMI was less clear. Regarding another component of food intake, association between depressive symptoms and consumption of savoury foods was mediated by disinhibition and eating for physical rather than emotional reasons. In summary, it seems essential to be aware of the presence of depressive symptoms and to pay attention to eating behaviors and attitudes in interventions among weight-preoccupied women.

Carpenter, K.M., Hasin, D.S., Allison, D.B. and Faith, M.S. (2000) Relationships between Obesity and DSM-IV Major Depressive Disorder, Suicide Ideation, and Suicide Attempts: Results from a General Population Study. American Journal of Public Health, 90, 251-257.http://dx.doi.org/10.2105/AJPH.90.2.251

Onyike, C.U., Crum, R.M., Lee, H.B., Lyketsos, C.G. and Eaton, W.W. (2003) Is Obesity Associated with Major Depression? Results from the Third National Health and Nutrition Examination Survey. American Journal of Epidemiology, 158, 1139-1147.http://dx.doi.org/10.1093/aje/kwg275

Dykes, J., Brunner, E.J., Martikainen, P.T. and Wardle, J. (2004) Socioeconomic Gradient in Body Size and Obesity among Women: The Role of Dietary Restraint, Disinhibition and Hunger in the Whitehall II Study. I International Journal of Eating Disorders, 28, 262-268.http://dx.doi.org/10.1038/sj.ijo.0802523

Laessle, R.G., Tuschl, R.J., Kotthaus, B.C. and Pirke, K.M. (1989) A Comparison of the Validity of Three Scales for the Assessment of Dietary Restraint. Journal of Abnormal Psychology, 98, 504-507.http://dx.doi.org/10.1037/0021-843X.98.4.504

Society has come a long way over the past several decades from the old fashion belief that cardiovascular disease (CVD) is a man’s disease. Throughout the years, gender-based studies have provided compelling evidence to uncover several unique features in disease presentation, pathology and primary prevention in women. Studies reviewing differences among men and women have placed specific emphasis on cardiovascular risk factors, symptoms and vascular pathology as potential etiologies for the higher cardiovascular mortality and disability among women. In addition, although weight loss and exercise have been shown to promote cardiovascular health in men, more recently findings have presented data to support the importance of these interventions among women. Although tremendous strides have been made throughout the years in the gender-based cardiovascular research, more questions than answers remain and additional research efforts are still needed to better understand the disease process in women. The objectives of this review are two-fold: First, to present a comparative analysis focusing on evidence-based similarities and differences among males and females in cardiovascular disease presentation, detection and clinical pathology; Second, to offer insights highlighting recent findings regarding primary prevention and treatment protocols in women. Based on our current knowledge, continued efforts geared toward optimal diagnostic testing and screening protocols for primary disease detection and risk factor modification programs are recommended. This would include further investigations of the potential role that genetics and/or environment play/plays in the natural progression of the disease process. Additionally, comprehensive lifestyle interventions aimed at reducing cardiovascular disability and mortality in women is also recommended.

Celermaier, D.S., Sorenson, K.E., Spiegelhalter, D.J., Georgakopoulos, D., Robinson, J. and Deanfield, J.E. (1994) Aging Is Associated with Endothelial Dysfunction in Healthy Men Years before the Age-Related Decline in Women. Journal of the American College of Cardiology, 24, 471-476.http://dx.doi.org/10.1016/0735-1097(94)90305-0

The health burden of myocardial infarction is rising for middle-aged women and they are underrepresented in research of cardiovascular diseases. The aim of this qualitative study was to explore how life had been for middle-aged women before they suffered a myocardial infarction (MI). Through a health care register, we identified all women (n = 46) under 65 years of age in a defined region in southeast Sweden who had suffered an MI the past 2 years and a strategic selection of n = 16 women from these was made. These selected women were interviewed and their narratives were interpreted by qualitative content analysis. The qualitative interviews generated five general themes: “Serious life events”, “Negative affectivity”, “Loneliness”, “Being a good girl” and “Lack of control”. The interviews revealed that many of these women had been exposed to extreme and repeated traumatic life events in their lives. Many had a cynical attitude towards others, felt lonely and experienced a lack of social support. Many of these women endeavored to “be a good girl”, which was a special psychosocial phenomenon found. This study uncovered that these women before they suffered an MI were affected by a variety of psychosocial factors. The study stresses the importance of psychosocial risk factors in the assessment of middle-aged women’s risk profile for MI. A general conclusion for clinical practice is that in the assessment of the individual risk for myocardial infarction for middle-aged women, potential psychosocial factors might also be considered.

Low, C.A., Thurston, R.C. and Matthews, K.A. (2010) Psychosocial Factors in the Development of Heart Disease in Women: Current Research and Future Direction. Psychosomatic Medicine, 72, 843-854.http://dx.doi.org/10.1097/PSY.0b013e3181f6934f

Genital cancers in women play an important role in cancer pathology in the developing countries. Objectives: This study aimed at clarifying the epidemiological and histopathological aspects of woman genital cancers in C?te d’Ivoire. Materials and Methods: This was a retrospective and descriptive study conducted in the anatomical pathology laboratories of the university hospitals in Abidjan. The study was carried out over a period of twenty-four years (1984-2007). The variables studied were: frequency, age, histological type and prognosis. Results: Genital cancers in women accounted for 41.28% (n = 2491) of cancer in women and 21% of cancers. The average age of patients was 46.65 years (range 2 – 88 years). The cervix (82.85%) was the main location followed by the ovary (8.6%). Histologically, carcinomas (92.93%) were the most common types of sarcomas. Cervical cancers were diagnosed at an average age of 47.36 years (range 2 to 88 years). Carcinomas were the predominant histological type (92.88%) with 57.4% (n = 450) diagnosed at pT2N0M0 stage. The average age of patients bearing ovarian cancer was 39.13 years (range 8 to 82 years).Common malignant epithelial tumours were the most common histological type (57.48%) (n = 123) followed by non-Hodgkin lymphoma (14.95%). Conclusion: Genital cancers in women are common and poorly prognosed in Cote d’Ivoire. The adoption of a policy of routine screening is needed to improve the prognosis of these tumours.

Epilepsy is one of the most frequent neurological disorders. In these circumstances, more than 25% of the patients are women of reproductive age. The aim of our research was to analyze the effectiveness and safety of antiepileptic therapy in women with epilepsy during pregnancy and to analyze the pregnancies’ outcomes. We included in our research 121 pregnancies of 101 women aged at the moment of childbearing about 26.9 ± 4.57 years old. Idiopathic forms of epilepsy were predominant among all causes—47.1% (р < 0.01). Of all cases, 65.4% remained seizure-free from generalized tonic-clonic seizures (GTCS), including 69.6% of all idiopathic epilepsy cases and 68.6% among symptomatic ones. The antiepileptic drugs (AED) dosages were exceeding teratogenic level at the moment of conception in 54.7% of the cases. Worse control of epileptic seizures was associated with Benzobarbital (66.7%) and Lamotrigine (50.0%). Women with epilepsy did not receive specialized neurological therapy before conception in most cases, which leaded to the usage of AED teratogenic doses and less effectiveness of AED during pregnancy. It is necessary to plan the pregnancy and prescribe rational treatment for epilepsy starting at the stage of planning and during gestation in order to obtain a better seizures control and to decrease congenital disorders risk in fetus.

Introduction: The incidence of stroke has decreased in Sweden as well as in most developed countries, but a high number of migrants have arrived in Sweden, during the last decades, which may have influenced the incidence. Aim: The aim of this study was to examine the incidence of stroke in women, born outside as well as in Sweden. Furthermore, the aim was to examine how socio-economic factors, smoking, and physical activity could modify the risk for stroke. Method: Data from the “Malmö Diet and Cancer Study” was used for the analysis. In total, 16,857 women were included (14,849 of them born in and 2,008 born outside Sweden), aged 45 – 73 years with a mean age of 57.4 years. Result. A significantly increased relative risk (RR) was found for the incidence of stroke for current smokers in both Swedish-born and migrant women. In Swedish-born women the RR was 1.98 (CI: 1.66 – 2.36) and for migrant women the RR was 1.83(CI: 1.13 – 2.96). The adjusted relative risk for the incidence of stroke in Swedish-born women performing moderate/high physical activity was RR 0.71 (CI: 0.61 – 0.84) and for migrant women it was RR 0.77 (CI: 0.49 – 1.20). The relative risk in relation to low socio-economic circumstances (SES) was significant only for Swedish-born women (RR 0.85 [CI: 0.73 – 0.99]). Among currently smoking Swedish-born women with a low SES the RR was 1.27 (CI: 1.03 – 1.57) in comparison with smoking migrant women, whose RR was 1.68 (CI: 0.92 – 3.09). Conclusion: No differences were found indicating that migrant women in this population had a higher risk as compared to Swedish-born women. However, migrant smoking women were more vulnerable to stroke compared to Swedish-born women. Physical activity was effective in reducing the risk of stroke among the total population and especially in the Swedish-born women. To increase physical activity in middle-aged women, in both migrant and Swedish-born women, is a highly recommended public health strategy.

Rosvall, M., Ostergren, P.O., Hedblad, B., Isacsson, S.O., Janzon, L. and Berglund, G. (2000) Occupational Status, Educational Level, and the Prevalence of Carotid Atherosclerosis in a General Population Sample of Middle-Aged Swedish Men and Women: Results from the Malmo Diet and Cancer Study. American Journal of Epidemiology, 152, 334-346.http://dx.doi.org/10.1093/aje/152.4.334

Mackenbach, J.P. and Bakker, M.J. for the European Network on Interventions and Policies to Reduce Inequalities in Health (2003) Tackling Socioeconomic Inequalities in Health: Analysis of the European Experiences. Lancet, 362, 1409-1414.http://dx.doi.org/10.1016/S0140-6736(03)14639-9